1Rheumatology Department., The County Hospital, Hereford, Hereford, United Kingdom

Abstract

Background Tennis elbow is a common disorder affecting approximately 1% of the general population annually. Treatments have historically focused on treating inflammation although in chronic tendinopathy the pathological process is primarily tendon degeneration and disordered healing. We undertook a survey to ascertain current treatment practices amongst Rheumatologists particularly the use of corticosteroid injections.

Objectives We aimed to ascertain the most popular current treatment practices for tennis elbow amongst Rheumatologists.

Methods Rheumatologists were surveyed using a simple questionnaire. A clinical scenario of a patient with a 3-month history of tennis elbow and no previous treatment was presented. Clinicians were asked to rank their preferences from a list of readily available treatments. The top 3 treatment choices were included for analysis.

Results 40 completed questionnaires were available for analysis. Of first preference treatment physiotherapy interventions were most commonly chosen with eccentric exercise (22.5%) the most popular single specified intervention. Corticosteroid injection was the second most popular primary intervention (20%). A total of 77.5% of rheumatologists would include physiotherapy as a top 3 treatment choice with splinting (52.5%) the next most popular modality. Corticosteroid injection was included as a top 3 treatment choice by 47.5% of Rheumatologists.

Conclusions Although physiotherapy and splinting are popular treatment preferences for tennis elbow nearly half of surveyed rheumatologists would consider corticosteroid injection a top 3 treatment choice. This is despite evidence that longer-term outcomes from corticosteroid injection can be worse even than no active intervention. Why corticosteroid continues to be so popular remains open to debate although the ease of the procedure, a traditional view of tennis elbow as an inflammatory process and often encouraging early outcomes from injection are likely playing a part. Improved understanding of the pathology underlying tennis elbow among rheumatologists, as well as increasing evidence for the use of exercise regimes such as eccentric stretching and newer injectable agents, such as platelet rich plasma, may change this current position.

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